For most Southerners, the word “moonshine” conjures up an image of a toothless hillbilly in overalls swilling from a crockery jug. But old-fashioned notions about moonshine consumption cease to be funny when drinkers turn up with lead poisoning from the illegally brewed liquor, as Emory researchers at Atlanta’s Grady Hospital recently discovered.

Moonshine is readily available in urban Atlanta and enjoyed by a surprising number of city-dwellers, says Brent Morgan, assistant professor of emergency medicine at the School of Medicine and lead author of a moonshine study published in the Annals of Emergency Medicine. The study had its genesis in the spring of 2000, when four adult patients showed up at Grady with potentially deadly lead levels in their blood. Three of the patients were having seizures, the fourth severe abdominal pain. All said they had been drinking moonshine.

Over the course of the study, researchers spoke with 581 patients, 8.6 percent of whom admitted to drinking moonshine within the past five years. Of those, 26 percent had swigged it within the previous week. The group of moonshine drinkers at Grady, an inner-city hospital, were more likely to be men between forty and fifty and were heavy drinkers–five to six times per week, in significant quantities. Eighty-eight percent of those studied were African American. Moonshine consumption was closely connected with elevated blood lead levels.

At first Morgan and his team were taken aback to find moonshine in the city, where twenty-four-hour package stores abound.

“But when you look at the history of moonshine,” he says, “it’s been around for a long time. It’s cheaper than regular liquor, you can buy it on Sunday, and it’s considered tougher and harder than the flavored store whiskey. It’s just never completely gone away. There were these massive crackdowns in the 1950s and ’60s trying to get rid of it, but it’s been kind of passed down through the culture. These [users] are the old-time, hard drinkers.”

Moonshine, also called street gin, corn liquor, and white lightning, is defined as any illicitly distilled liquor or whiskey. It’s typically made from mixing corn and yeast and allowing the substance to ferment, then heating the mash to the boiling point of alcohol. The steam, which has a higher concentration of the buzz-producing ethanol than the original mash, is collected using either a series of lead or lead-soldered pipes or a car radiator. It’s in the condensation process that lead seeps into the drink.

Some of the Grady patients Morgan interviewed said they buy their moonshine from stills right in Atlanta, while others get it from north and south Georgia. It costs about $1.25 to $3 a pint, double on Sunday. Most of the bootleggers are white, guesses Morgan, and may have learned the trade from fathers or older relatives whose skill dates back to segregation, when alcohol could not legally be sold in black neighborhoods. Bootleggers would buy off police to be able to operate in these areas, also making huge donations to religious zealots who favored outlawing liquor altogether–helping to keep the bootleggers in business.

“It was quite a racket,” Morgan says.

In 1951, Atlanta saw one of the most famous outbreaks of moonshine poisoning in U.S. history: a white bootlegger, Fats Hardy, ran out of ethanol while making a batch and replaced it with methanol, poisoning some 323 customers and killing forty. Hardy was convicted of murder, although he continued to proclaim his innocence (due to ignorance of the harmful effects of methanol) from jail.

The cases of lead poisoning Morgan has seen recently may be less dramatic, but like any illegally concocted street drug, moonshine drinking is still a dangerous gamble.

“Exposure at lower levels for a longer amount of time can have effects doctors don’t connect with lead,” he says. “Unfortunately, we keep finding that lower and lower levels are associated with adverse health effects. It can be a tough thing to diagnose.”–P.P.P.